Acne and pimple-related skin concerns are very common. Today, acne scar treatment-especially for scars and marks on the face-can often be planned effectively with modern dermatology and aesthetic medicine approaches. In addition to acne scars, scar treatment for various types of skin marks may also be performed using different techniques depending on the skin's needs.
Mild acne may sometimes resolve on its own, and in some individuals it may heal without leaving visible marks. However, acne lesions that form deep nodules or cysts are more likely to require professional evaluation and treatment. Severe acne has a higher probability of leaving scars, and spontaneous improvement without marks is less common. Before discussing treatment options, it is helpful to understand the main types of acne scars.
How Many Types of Acne Scars Are There?
Acne scars are generally evaluated in two broad groups:
- Superficial acne marks
- Deep acne scars
Superficial Acne Marks
Superficial marks affect the upper layers of the skin and usually do not extend deeply. They often appear reddish and may cause very mild surface irregularities. Because they are closer to the surface, treatment planning for these marks is often faster compared to deeper scars.
Deep Acne Scars
Deep acne scars are commonly classified into three main categories:
- Ice pick scars
- Boxcar scars
- Rolling scars
Ice Pick Scars
These scars may look as if the skin was pierced by a sharp object. The diameter is typically less than 2 mm, and the depth may also be around 2 mm, sometimes extending down toward the fatty layer beneath the skin.
Boxcar Scars
Boxcar scars often have a round or oval shape and may be around 0.5 mm deep. They can create a vertical depression and typically have sharper edges, sometimes resembling a crater-like appearance. Compared to ice pick scars, they tend to be less narrow and "pinpoint."
Rolling Scars
Rolling scars can cause a wavy or uneven texture on the skin. They may be deeper and broader (sometimes around 4 mm), and they often create visible depressions across a wider area.
How Is Acne Scar Treatment Performed?
Thanks to advances in medical technology, acne scar removal treatments can be performed using multiple techniques. The most appropriate option is usually determined after a basic skin analysis and clinical assessment of scar type, depth, and skin sensitivity. Some of the most commonly used treatment options include:
Treatment for Superficial Acne Marks
Methods aimed at achieving visible improvement in a shorter time may be preferred for superficial acne marks. Chemical peeling is among the most frequently used options. In addition, treatments such as dermaroller / microneedling, PRP, or laser skin resurfacing may be considered depending on the scar pattern and skin structure. Mesotherapy may also be used as a supportive treatment option.
Ice Pick Scar Treatment
For ice pick scars, microneedling (dermaroller) is commonly used. PRP, TCA, and chemical peeling may be recommended depending on the skin assessment. More advanced techniques such as fractional CO2 laser and radiofrequency microneedling (gold needle / RF microneedling) may also provide meaningful improvement in selected cases.
Boxcar Scar Treatment
Boxcar scars may require more intensive approaches such as deep chemical peeling. PRP and fractional laser can also be used. Recently, radiofrequency microneedling, punch elevation, and combination protocols have become increasingly popular for this scar type.
Rolling Scar Treatment
Rolling scars differ from many other acne scar types and often require a stronger treatment strategy. Methods such as standard chemical peel or spot TCA may not provide sufficient results alone. For rolling scars, treatments such as subcision and dermal fillers may be recommended to address the underlying fibrous bands that pull the skin downward.
Subcision and Filler for Rolling Scars
In rolling scar treatment, subcision involves releasing fibrous bands beneath the skin. This helps the upper layer of the skin become freer and less tethered. After subcision, filler injection may be used to reduce the appearance of depressions and support a smoother surface.
It is important to note that results from fillers are not permanent, and maintenance treatments may be required over time. This method can typically be applied in all seasons, and many patients can return to daily activities shortly after treatment. It is generally considered a well-tolerated approach and may be suitable for both lighter and darker skin tones based on medical evaluation.
Fractional CO2 Laser for Acne Scars
Fractional CO2 laser can help remove damaged surface layers and stimulate collagen production in deeper layers of the skin. It is frequently used in both moderate and deep acne scar treatment.
In many cases, sessions may be performed in intervals of approximately 4 weeks, and a plan of 4 to 8 sessions may be considered depending on scar severity. For mild scars, fewer sessions (such as 2 to 4) may be sufficient. Temporary side effects such as redness or peeling often resolve within about one week. After laser treatment, protecting the skin-especially from sun exposure-is essential.
Radiofrequency Microneedling (Gold Needle RF) for Acne Scars
This method works in two primary ways. First, microneedles create tiny controlled channels on the skin surface, which triggers the natural wound-healing process and supports skin renewal. Second, delivering radiofrequency energy into deeper layers can increase collagen remodeling through controlled heat.
Radiofrequency microneedling is often performed in 3 to 4 sessions with around 4-week intervals. One of the areas where this treatment may be particularly beneficial is acne scarring, and it can be considered for patients with uneven texture and scar depressions.
PRP and Mesotherapy for Acne Scar Treatment
PRP and mesotherapy are treatments that may support collagen production and skin repair. They can help improve the appearance of superficial scars and overall skin quality. They may also be used in scar treatment protocols beyond acne scars.
However, these methods may not be sufficient alone for very deep scars. In deeper scar patterns, PRP and mesotherapy may be combined with more advanced options such as fractional laser or radiofrequency-based treatments to enhance overall improvement. These treatments are often planned at intervals of about one month, and protocols may include approximately 4 to 8 sessions depending on the clinical evaluation.
Treatment Process
The treatment process for acne scars and acne marks may vary depending on the method selected. For this reason, it is not possible to define a single standard protocol that applies to everyone. In some cases, a single session may provide noticeable improvement. In other cases, a multi-session plan may be recommended for more effective and balanced results.
The number of sessions mainly depends on factors such as:
- the type of acne scar (superficial vs. deep scars such as ice pick, boxcar, or rolling scars),
- the size of the affected area,
- overall skin structure and sensitivity,
- and how the skin responds to treatment.
Before starting treatment, a clinical assessment and basic skin analysis are performed. Based on this evaluation, you will be informed about the most suitable treatment option (such as fractional laser, RF microneedling, chemical peeling, PRP/mesotherapy, or combination protocols) and an estimated session plan.
After the Procedure
In acne scar and acne mark treatments, many techniques are designed to reach not only the skin surface but also the deeper layers of the skin. For this reason, it is important to follow specific aftercare recommendations to support healing and achieve the best possible results.
Depending on the treatment method used, the aftercare instructions may vary. However, it is common to experience temporary skin sensitivity after the procedure. This sensitivity may last for a few days, and mild side effects such as redness or slight irritation can occur. These reactions are typically short-term and expected, especially after treatments such as laser resurfacing, RF microneedling (gold needle), chemical peeling, PRP, or mesotherapy.
Another essential point is sun protection. After treatment, the upper layer of the skin becomes more vulnerable to UV exposure, so using a high-SPF sunscreen is strongly recommended.
Additional precautions may apply depending on which procedure was performed. If you follow your doctor's aftercare instructions carefully, the recovery period is usually smooth and comfortable.
